Prometric Exam Questions for Neurology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the NRO5011 Paper

The neurology specialist paper (NRO5011) is written for the neurology registrar: the stroke call with the clock running, the patient still seizing, the headache that is a bleed, the weakness that is Guillain-Barré, and the long-term management of epilepsy, multiple sclerosis and Parkinson's disease. Stroke services are expanding across the Gulf, and the paper reflects it. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the neurologist guide. For timed papers use the Neurology specialist bank, about 2,400 questions.

Stroke

Question 1

A 65-year-old presents 90 minutes after onset of right hemiparesis and aphasia, NIHSS 14, with no haemorrhage on CT and a left M1 occlusion on CT angiography. The treatment is:

1. Aspirin alone
2. Intravenous thrombolysis immediately followed by mechanical thrombectomy, since large-vessel occlusion within 6 hours (and up to 24 hours with favourable perfusion imaging) benefits from both
3. Thrombectomy only after 24 hours of observation
4. Heparin infusion

Answer: B. Bridging thrombolysis plus thrombectomy is standard for eligible large-vessel occlusion. Blood pressure is kept below 185/110 before lysis and 180/105 after.

Question 2

A patient with a transient ischaemic attack has an ABCD² score of 5 and no AF. Secondary prevention started within 24 hours should include:

1. Warfarin
2. Dual antiplatelet therapy with aspirin and clopidogrel for 21 days then single antiplatelet, high-intensity statin, blood pressure control and urgent carotid imaging with endarterectomy for symptomatic stenosis of 50 to 99% within two weeks
3. No treatment until MRI
4. Thrombolysis

Answer: B. Short-course DAPT after minor stroke or high-risk TIA reduces early recurrence; carotid surgery benefit is greatest in the first two weeks.

Question 3

A 50-year-old has a thunderclap headache with neck stiffness; CT within six hours of onset is normal. The next step is:

1. Discharge with analgesia
2. Lumbar puncture at least 12 hours after onset looking for xanthochromia if CT is negative beyond the early window, or CT angiography where CT was performed early and the protocol supports it; treat confirmed subarachnoid haemorrhage with nimodipine and urgent neurosurgical or endovascular aneurysm management
3. Triptan
4. Repeat CT in a week

Answer: B. A modern CT within six hours is highly sensitive, but a thunderclap headache is subarachnoid haemorrhage until excluded by the local pathway.

Epilepsy

Question 4

A patient has been in generalised convulsive status epilepticus for 10 minutes despite one dose of intravenous lorazepam. The next step is:

1. Wait another 10 minutes
2. A second benzodiazepine dose if not already given, then a second-line agent such as levetiracetam, valproate or phenytoin/fosphenytoin at full loading dose, with anaesthetic induction and ICU for refractory status at 30 to 60 minutes
3. Oral carbamazepine
4. Immediate propofol without second-line therapy

Answer: B. Check glucose and give thiamine where indicated. Time-based escalation prevents neuronal injury; levetiracetam, valproate and fosphenytoin are equally effective second-line agents.

Question 5

A 24-year-old woman with newly diagnosed focal epilepsy plans to have children in the next few years. The most appropriate first-line antiseizure medication is:

1. Valproate
2. Lamotrigine or levetiracetam, with folic acid, avoiding valproate because of teratogenicity and neurodevelopmental harm
3. Phenobarbital
4. Topiramate at high dose

Answer: B. Valproate is contraindicated in women of childbearing potential without a pregnancy prevention programme. Enzyme-inducing drugs also reduce contraceptive efficacy.

Question 6

A patient has had a single unprovoked tonic-clonic seizure with a normal examination, normal MRI and normal EEG. Regarding treatment and driving:

1. Start lifelong medication and allow driving next week
2. Treatment is not mandatory after a single seizure with normal investigations because recurrence risk is about 30 to 40%; discuss risks, and apply the local driving restriction, which in Gulf states typically requires a seizure-free period before resuming
3. No counselling needed
4. Surgery

Answer: B. Two unprovoked seizures, or one with abnormal EEG or imaging, define epilepsy and warrant treatment. Driving and occupational advice is part of every seizure consultation.

Headache and demyelination

Question 7

A 30-year-old woman has 10 migraine days a month despite triptans and lifestyle measures. Preventive options include:

1. Daily triptans
2. Propranolol, topiramate, amitriptyline or candesartan, with CGRP monoclonal antibodies or onabotulinumtoxinA for chronic or refractory migraine, and limiting acute medication to avoid medication-overuse headache
3. Daily codeine
4. Oxygen therapy

Answer: B. Preventives are offered from about four migraine days a month. Oxygen is for cluster headache; opioids are avoided.

Question 8

A 28-year-old has optic neuritis and, two years earlier, an episode of leg numbness lasting three weeks. MRI shows periventricular, juxtacortical and spinal cord lesions, some enhancing. The diagnosis and treatment approach are:

1. Migraine; triptans
2. Relapsing-remitting multiple sclerosis meeting dissemination in space and time; treat the relapse with high-dose methylprednisolone and start disease-modifying therapy early, choosing agent by disease activity and family planning
3. Vitamin B12 deficiency; injections only
4. Stroke; aspirin

Answer: B. McDonald criteria allow diagnosis at a single MRI with enhancing and non-enhancing lesions. Neuromyelitis optica spectrum disorder is excluded with aquaporin-4 antibodies because its treatment differs.

Movement and neuromuscular disorders

Question 9

A 68-year-old has a resting tremor, bradykinesia and rigidity, worse on one side, with a good response to a levodopa challenge. The most likely diagnosis and first-line treatment are:

1. Essential tremor; propranolol
2. Idiopathic Parkinson's disease; levodopa for motor symptoms affecting function, with dopamine agonists or MAO-B inhibitors as alternatives in younger patients, and attention to non-motor symptoms
3. Drug-induced parkinsonism; more haloperidol
4. Huntington's disease; tetrabenazine

Answer: B. Asymmetric onset and levodopa responsiveness support PD. Early falls, poor levodopa response or autonomic failure suggest an atypical parkinsonian syndrome.

Question 10

A 35-year-old develops ascending symmetrical weakness and areflexia over five days, two weeks after a diarrhoeal illness, with a forced vital capacity of 1.2 L. The management is:

1. Outpatient physiotherapy
2. Admission with serial vital capacity and ECG monitoring, intravenous immunoglobulin or plasma exchange for Guillain-Barré syndrome, and ICU with intubation if vital capacity falls below about 15 to 20 mL/kg or bulbar weakness develops
3. Oral steroids
4. Antibiotics for Campylobacter only

Answer: B. Steroids do not help GBS. Respiratory and autonomic monitoring drive the decision to intubate; DVT prophylaxis and pain management are part of care.

Question 11

A patient with myasthenia gravis develops worsening dyspnoea, dysphagia and a vital capacity of 1 L after starting an aminoglycoside. The management is:

1. Increase pyridostigmine and send home
2. Treat as myasthenic crisis: ICU admission, elective intubation if vital capacity or bulbar function is failing, plasma exchange or IVIG, review of precipitating drugs, and steroids started once the airway is secure
3. Edrophonium test only
4. Beta blockers

Answer: B. Aminoglycosides, fluoroquinolones, magnesium and beta blockers worsen myasthenia. Steroids can transiently worsen weakness and are introduced carefully.

Dementia, infection and emergencies

Question 12

A 70-year-old has 18 months of progressive memory loss, a normal examination and an MMSE of 20, with hippocampal atrophy on MRI and normal B12, TSH and syphilis serology. The management is:

1. Antipsychotics
2. Diagnosis of probable Alzheimer's disease, an acetylcholinesterase inhibitor such as donepezil, carer support, driving and safety advice, and management of vascular risk factors; memantine for moderate to severe disease
3. No treatment, as nothing helps
4. Lumbar puncture monthly

Answer: B. Reversible causes are excluded first. Disease-modifying anti-amyloid antibodies exist for early disease in some markets, with strict criteria and monitoring.

Question 13

A 40-year-old has fever, confusion, a focal seizure and temporal lobe changes on MRI with lymphocytic CSF. The treatment is:

1. Wait for PCR results before any treatment
2. Start intravenous aciclovir immediately for presumed herpes simplex encephalitis, continuing for 14 to 21 days if PCR is positive, with antibiotics for bacterial meningitis until excluded
3. Oral antivirals
4. Steroids alone

Answer: B. Delay in aciclovir increases mortality and disability. Autoimmune encephalitis is considered if infectious work-up is negative.

Question 14

A 55-year-old has progressive asymmetric limb weakness with fasciculations, brisk reflexes and no sensory loss over eight months. The most likely diagnosis and the investigation to confirm are:

1. Peripheral neuropathy; nerve conduction studies showing sensory loss
2. Motor neurone disease (amyotrophic lateral sclerosis); electromyography showing widespread denervation with preserved sensory studies, after excluding cervical myelopathy by imaging
3. Multiple sclerosis; MRI brain
4. Myasthenia; antibodies

Answer: B. Mixed upper and lower motor neurone signs without sensory involvement define ALS. Riluzole, multidisciplinary care and early discussion of ventilation and nutrition are the management.

Question 15

A patient with a history of lung cancer develops bilateral leg weakness, a sensory level at T8 and urinary retention over 48 hours. The immediate management is:

1. Outpatient MRI in two weeks
2. High-dose dexamethasone immediately and urgent whole-spine MRI for metastatic spinal cord compression, with neurosurgical or radiotherapy treatment within 24 hours
3. Physiotherapy
4. Catheter only

Answer: B. Neurological outcome depends on function at the time of treatment; patients still walking at diagnosis usually remain ambulant if treated promptly.

How to use these questions

• Learn the time-critical pathways: stroke, status epilepticus, subarachnoid haemorrhage, encephalitis, cord compression, GBS and myasthenic crisis.
• Know the drug rules: valproate in women, enzyme inducers and contraception, drugs that worsen myasthenia.
• Cover chronic disease management: epilepsy, MS, PD and migraine prevention, where guidelines have moved recently.
• Practise under time in the Neurology bank with the error-log method.

Neurosurgeons have their own bank (neurosurgery guide). Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the neurology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include neurophysiology and neuroradiology?

At the level of ordering, interpreting and acting on EEG, nerve conduction studies and imaging, not performing them.

Can a DM or MRCP neurology holder skip the exam?

Often, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.